Tuesday, March 31, 2009

Before I begin- before I forget, lemme let out something I been meaning to mention since i started this blog: if you and me are walking down the street one day and- god forbid- some nice little old lady gets steamrolled by a mack truck, or some dude decides to check out off a building ledge or any of the other imaginative-ass ways people find to get themselves collected into the underworld takes place- it’s not gonna be a whole heroic rushing to the rescue situation. Music won’t swell. I won’t be pulling any granny’s from flaming cars and I definitely won’t be sticking pins into people’s throats and breathing for them. Probably, I’ll tip my hat and walk away, because without a bag of equipment and some gloves, I’m just another dude on the street except I would be able to imagine what I would do and not be able to do it. Which would suck. For me and the unfortunate patient.

Having said that, there are 2 exceptions. The first is non traumatic cardiac arrest- cardiac arrest because CPR only requires hands- (the American Heart Association recently took mouth to mouth out of the equation cuz no one wanted to do it and compressions work well on their own. holla. ) and non traumatic because traumatic cardiac arrests usually involve lots of blood, and I love humanity and all but not enough to catch something nasty from some stranger. Aaaand traumatic cardiac arrests rrrrarely make it anyway.
The second exception would be the choke and by choke I don’t mean the guy holding his hands to his throat going Oh my god I’m…I’m choking! I’m choking dammnit! Because someone who tells you they’re choking is like someone telling you they’re in cardiac arrest- it means they’re not. Real chokes don’t talk, they’re too busy turning blue and coding and I’m too busy getting my forceps out and putting em down their throat. They don’t turn red. They don’t cry and moan. And usually, they were eating right before it happened, not talking on the phone with their ex like most CHOKE calls we get. But yes, for the real legit, bluefaced not talking not demand making not EDP or recently dumped choke, the good old heave ho on the tummy will do the trick most of the time and make all the difference.
So there you have it.
Now on to the subject of tonight’s pleasant/gruesome chat.

1.
I was pleasurably napping on my couch yesterday when all the sudden I was downstairs in a strange duplex and people were filing out of some meeting on the second floor. An old scruffy fellow with a beard came up to me and sort of collapsed onto me, getting his drool all over my shirt. I lifted him up and he puked on the floor and looked like he was about to check out as I was waking up.
Damnit- I thought, back to work already…

2.
Later that night:
You can tell this job’s gonna be retarded from the way it comes over on the screen. It’s an UNCONCIOUS and the text says “FEMALE CALLER STATES MAY HAVE LO BLOOD SUGAR” so you already know the lady is not unconscious at all, but lucid enough to be already trying to rationalize Why she called 911 and told the operator she wasn’t conscious. And it’s at a bar. Any UNCONSCIOUS at a bar sucks on principle cuz it automatically means the patient’s having more fun than we are.

When Mr C and I pull up outside 1 of these new trendy spots on Myrtle, a short white guy approaches the bus. He has thick glasses and a little hair left and carries himself like he owns the place but doesn’t want to throw it in your face but wants to make sure you know but doesn’t want any trouble either. The creases on his forehead say that he’s gonna try to maintain calm and keep control even though he’s very fucking concerned about how this looks for the business. He immediately irritates the shit outta me so I open the window just a quarter of the way. He wraps his anxious little fingers around the edge of the window and gets up on tippytoes to peer in at us.
Um- excuse me…
Yes, can we help you?
Yes, um, there is a lady inside, she was shaking, and she said that um, her sugar might be low, and um so now though she’s like, unconscious and so we you know called and she’s inside so maybe you could you know…um. Yeah.
Okay.
I roll up the window.

The bar is all wide eyes and whispers. The unconscious lady has decided to stay in the back area and she’s moaning and carrying on, waving her hands in the air in the midst of a small crowd of onlookers. She’s middle aged and fattish with an indigo girls haircut leftover from 1992. Predictably, she’s trashed.
Oh god! She’s yelling in a thick british accent. God, this is- this is so Not Me! I just- I don’t know what’s wrong with me, it’s like…I’m like…It’s like I’m perhaps I’m or my sugar is low!
Are you a diabetic? Mr C asks.
No, but I mean, oh it’s crazy, I’m so, I’m so embarrassed. I mean…
Ma’am, could you hold still a second?
I mean, I’m so- this is so not me. I can’t even, oh godddddd
Ma’am, stop writhing please and sit in this nice orange chair.
(Patience waning, waning away)
It’s like…oh! I’m so embarrassed. Perhaps it’s you know, something menopausal, you know, like I don’t know, I feel so weird, perhaps it’s something with menopause…
Perhaps, I suggested, it’s that you’re drunk.
At this point her friend chimes in helpfully- Oh, she wasn’t drinking tonight!
Mostly without meaning to, both me and my partners’ eyebrows raise with wonder.
I say that I think maybe she was, just a little.
Just three vodka tonics, says the patient, but that can’t be it…

Everyone stares as we wheel her out, which usually bothers me, but this one’s still moaning and carrying on so much it’s hard not to think that she’s feeding on the attention. When we load her into the bus she enters the apologizing drunk lady phase, starting with a thick round of Oh god, I’m so sorry boys, I’m really really really really- uh sorry. Oh, I think I’m gonna be sick again, oh my god- like, i”m really really sorry, guys. I’m really embarrassed and I really think this is the menopause, you know, and maybe my sugar.
Must be some combination, dear, -the friend offers reassuringly. Some combination of chemicals, you know, in your body. Reacting to each other, you know? Not to worry- this isn’t you, darling, this isn’t you, just some combination of chemicals.
Yes, I think: alcohol and blood.

Drunk people l o v e to repeat shit, just in case in the retelling some new detail will emerge that makes it all make sense in that satisfying drunk way. And when you add a mostly drunk person to a completely drunk person, they usually end up repeating themselves and egging each other on to repeat things even more, ad nauseum (literally). So I was happy to be driving last night, and not sitting in the back listening to the pissfaced brit fest skip back to the beginning of the monologue again and again.

At Brooklyn Hospital, she decided that she needed a cool room please, and a clean bucket to be sick in, and that perhaps it was actually, you know, food poisoning.
Perhaps, my partner said, it was alcohol poisoning but she’d already cycled back to the low blood sugar theory and her friend was nodding enthusiastically.

some douche bag took this photo in Cali. Im not for this voyeuristic crap but im not against ripping it for my blog, especially when it's SO exactly what im talking about. Notice how the new guy looks like he's thinking about maybe treating her and the old dude in back is like "Don't even fucking consider it, a-hole." Classic. And that chair is HUGE.

3.
Even later that night:
Our EMTs are dealing with a drunken head trauma when another guy approaches them to say he’s having trouble breathing. So they call us to come handle it while they continue longboarding and collaring their guy. Our guy is outside on the stoop, puking and yelling that he can’t breath. It’s dark, so we don’t really get a good look at him till we’re inside the ambulance and starting the workup. He’s 59, a diabetic and has just been having shortness of breath all day but no chest pain, no bleeding, nothing else unusual at all. When he takes a breath you can hear the rustling of excess fluid frothing in his lungs. It sounds like someone sucking the last bits of soda out of a cup of ice and it means his heart’s failing.

There’s a few things I tell my students to look for when they’re trying to assess whether a respiratory distress patient is about to check out. They’re not medically proven and you won’t find them text books, but as someone who sees people on that gray breathless line between alive and dead fairly regularly, i can tell you they are almost without fail warning signs of someone looking to not make it.

The first is Non-Tolerance of Oxygen.
I can’t breath I can’t breath!
Ok, Here’s some oxygen, this’ll help.
No! I said I can’t breath damnit! Ah!
When someone’s so deep in their hypoxic stupor that they can’t even bear to have the O2 mask strapped to their face, I start looking at my tube kit.

The second sign of imminent respiratory and then cardiac arrest is the Toilet Spin- they start making crazy circles with their upper body like someone just flushed them down the big linoleum bowl of death. Their eyes stop looking at anything at all because the patient’s too busy trying to breath to bother seeing. It may be why we call it crapping out.

Finally, Everything That Once Was Fast Gets Slow, real slow. That fast thing is how the body compensates: They can’t breath, so the heart beats faster to pump more blood to the lungs and other vital organs. The respirations speed up to try and get more air in, but adds to the hypoxia and franticness. Sometimes a patient can keep going like this for a long time, their chest muscles flexing in and out in a desperate attempt to keep breathing, but eventually, exhaustion will kick in from all that hard work, and that’s when Everything That Once Was Fast Gets Slow. They’ll go from “OhmygodhelpmeIcan’tbreath

pleasedosomething” to “…uh…” and from gaspgaspgaspgaspgaspgaspgasp to gasp……………….gasp………………….gasp…………………gasp……………………………gasp.
That’s endgame.

This fellow had all that going on within minutes of getting on our ambulance. AND he had no veins for me to put an iv into. AND his lungs were quickly filling up with backedup fluid from his failing heart, so he was literally drowning inside himself, which is only a deep concept when you’re not watching it happen to someone right in front of you. Now, usually folks in this condition, it’s called Acute Pulmonary Edema, have extremely high blood pressure, which sucks a lot for them and could quickly kill them, but suck tho it may, it’s still much better than the ones with fluid filling up their lungs and NO blood pressure at all. Those guys are in whatscalled Cardiogenic Shock, and they’re fucked. That was this guy. He was cold to the touch. No one could find his blood pressure. His veins were collapsed. It was the kinda guy that you keep looking up at to make sure he hasn’t coded yet, even if he’s talking to you.

And he was talking away at first, while we were digging around in his hands for that lucky little flash of blood to tell us we had IV access and could get some life-saving meds in him. Then he got agitated, and started taking off his O2 mask, and me and Mr C exchanged a glance. Then we still couldn’t get a blood pressure or an IV and he started getting quiet, which is when I said “Imna start rolling.” As I hopped out of the back I saw him make a little sightless spin with his upper body.

When you’re a paramedic and the man you’ve been assigned to keep alive is about to die and you don’t have an IV, all you have left is you’re lights and sirens (this is why I don’t mess with patients when I aint working). I fucking flew to the hospital, my siren turned up to an ear shattering, frantic splatter that makes yuppy scum jump the fuck out the way and then look on irritably. Made it there in a minute and a half and by the time I opened up the back our man was in cardiac arrest, intubated and lifeless. Can’t say I was surprised. The only thing that didn’t fully add up about the situation was no chest pain- for someone to be in as much cardiac distress as he must’ve been, judging from his EKG and symptoms, he shoulda felt it, but diabetics are known to have whats called silent heart attacks, meaning you can catch and not know it.

In the hospital they put a central line in and got him back for about ten seconds before he coded again. They shocked him more than a few times, brought him back again, lost him again and last I checked he’d coded and revived a total of five times but was still alive and ticking all by himself.
What’s the story with this guy? The doctor wanted to know.
No history, I said, except the diabetes. No chest pain, he was just sitting on his stoop vomiting and looking like he was about to check out.
Then I remember my dream.

A five story walk-up on the Grand Concourse. Why do folks who need to be carried always live on the fifth floor or higher with no elevator? The patient’s wife opens the door and she looks like she’s not sure whether to be irritated or worried. (Strange to have our own expressions mirrored back to us for once.) She leads us inside where we find a pale, sweaty, agitated, half-drunk 40 year old with bags under his eyes, clutching his chest and yelling that he’s fine and he doesn’t need to go to the hospital so dejame en paz, carajo!...

We finally coax him to calm down and sit down and usher his teenage daughter and five year old son into another room. Turns out, the doctor told him that he ever drank again he’d have another heart attack.
And?
And I jus had a drink.
And?
And I’m fine. I’m- AAAAH MY CHEST!!! (Sweat sweat, clutch clutch…) But is not that bad, I swear!

It’s funny because…wait a minute, in writing that I realize that a lot of you might not find anything funny about a man having a heart attack in front of his whole family. And you’d be right not to. But in reading ahead i would encourage you to let go of preconceived notions and all that right/wrong junk and just appreciate what a pleasurable thrill the twisted disasters of life and death bring. That’s all. People die in horrible and ridiculous ways day after day and when you’re there to see it, well, sometimes all you can do is laugh- once all the busy work is done of course, and you’re having a cup of strong black coffee at the Lechoneria around the corner with your partner. It’s not that if you don’t laugh you’ll cry, it’s that if you don’t laugh you’ll become a fucking shell of a person who can’t function.

AAAAaaaaaaaaaaaaanyway, it’s funny because we spend SO Much time, Most of our Time, dealing with people that have no business at all calling 911, or even 311 for that matter, but really just want a little human touch. Okay, I’m full of sidetracks tonight, but I’m restless so bare with me- like the lady last week who said: “I was opening a window and I think I pulled a muscle and then my whole left side of my body went numb.”
And then what happened? (because you could tell there was more coming..)
So then I took my asthma pump and…
Wait, why’d you….nevermind
And it worked!
It did?!
Yeah, I can feel my left side again. But my pulled muscle is still kinda bothering me.
You wann go hospital?
Yeah!
(Later in the elevator)
By the way, ma’am, how long ago was it that you tried to open the window, an hour or two?
No, it was like three, no four day ago.
…

I really enjoyed that call, actually, because it really truly had me laughing. Like LMAO kinda laughing, not just a sardonic chuckle.

AAAaaanannnnnyyywayyyy again- back to the story at hand:
Where was I? Ah yeah- it’s funny Because: we spend all this time with folks that truly don’t need us, or our 40 pounds of equipment, and then here we have what turns out on the EKG, the 12 Lead and in every possible way to be a bonafide Myochardial Infarction AKA The Big One AKA a fricken heart attack- and homeboy has no intention of letting us treat him. We practically have to beg him to let us put an iv in, and all the while:
I’m fine, I’m fine, I’m fucking AAHAHAHAHA MY FUCKIN CHEST OH CONO CARAJO MY CHEST JESUS MARY AND JOSEPH!!!

When we finally convince him to come with us to the hospital and not commit suicide by stupidity in front of his family, he want s to walk down the 5 flights. Now, believe me- just about any other patient I would’ve actually hid the stair chair from so they didn’t get any dumb ideas about being carried, but the Llaaaast thng you wanna let someone having a heart attack do is walk down 5 flights of stairs. BUT- one the other hand, the last thing our patient wanted to do was get paraded out in front of his whole building looking weak and being carried in a gimpy EMS chair by another man. So we were at a standstill.

My partner and I wasted many graphic explanations of how the heart crinkles up and dies without oxygen and what it feels like when you’re lungs fill up with fluid and you drown inside yourself (more on that in some other posting, I’m sure…) trying to reason with our dude but it was no use. He didn’t even seem to be listening, mostly just sat there sweating and clutching his chest and whining that he was okay leave me alone, papa, estoy fucking …bien… (ow! Shit!...ow!)

Finally, I lost my patience, my temper and my cool all at once and launched into a satisfying, curse-laden tangent, (any of you who’ve seen my do a workshop…like that, but without the stupid smile…)…(why should patients be the only one’s who get to curse?)…

DUDE, I said, yer gonna die. In fact yer gonna fucking die, more than likely, on this staircase, in front of your family and it’s gonna suck AND me and my partner gonna haveta stick a tube down yer throat and pump on yer chest. . It won’t be poetic, it’ll just be ridiculous. I don’t like carrying people down 5 flights of stairs, but for you it’s how it has to be. Sit in my chair. Put this sheet over your head. And stop screaming in pain and saying you’re okay, cuz you’re not. Then, we go to the hospital. Okay?

I knew he would concede when he looked at me the way I look at some EDP’s (like the one hiding the rock in his sock). It’s a look that says: Are you gonna kill me or am I gonna kill you? Or are we just gonna fucking pretend to be friends and go to the hospital without a problem?

BUT…oh, the but.
Before he could go, he had to have a pep talk with his successor. And this…really, this was one of those moments that I could kinda feel civilization crashing around me.
Before I go, he said, Bring me my boy.
Someone brought the boy (age 5 remember).
Boy- he said. He said, Papi’s going away for a little while. You da man of the house now, hear? You in charge.
His grown ass wife and mostly grown ass daughter looking on, traces of embarrassment plain to see.
You running things round here, he continued. You the boss. Okay?
The boy nodded but his face said WHAT THE FUCK IS WRONG WITH YOU DAD?

And with that, we draped the sheet of shame over his head and carried his ass down the five flights to the ambulance.

Okay people- I realize as I’m scratching out all these stories that a lot of folks don’t have much idea what the this whole EMS thing is all about. So here’s a primer for those that’re interested.

Q: What the hell is EMS anyway?

A: EMS is the Emergency Medical Services. That’s the whole system. There’s the transport side, which is mostly when nursing homes, dialysis centers, etc have contracts with private companies and call an ambulance to get their clients towed back and forth inbetween, and then there’s 911- which is when you call 911 and someone at 9 Metrotech in downtown Brooklyn directs your call to EMS and a GPS system tells them which 911 ambulance is closer. 911 has private ambulance companies, hospital ambulances and FDNY ambulances in it, all doing the same job and each claiming the other is full of useless skells and lowlifes.

Q: What are you- EMT? Paramedic? What’s the difference?

A: There’s Basic Life Support and Advanced Life Support. EMT means Emergency Medical Technicians; they do BLS, which includes bandaging, immobilizing, bleeding management, delivery of oxygen and a few medications and transportation to the hospital. Paramedics (that’s me) do ALS, which involves more invasive procedures like giving IVs, intubation, needle cricothryoidotomy (putting a HUGE ass needle right below someone’s adam’s apple when they have an airway obstruction) and chest decompression (putting that same hugeass needle inbetween someone’s ribs to let the air out of their chest cavity when their lung collapses.) We also give medications, about 50 of them from Adenosine to Vasopressin, and are equipped to do for an asthma or heart attack what any Emergency Room would do in the first hour of treatment. If you call 911 and say you stubbed your toe they’ll send you EMTs. If you say you stubbed your toe and your chest hurts, you’ll probably get medics. If you tell them you stubbed your toe and now you’re dead, they’ll send both. It’s happened. Sometimes EMTs will get called for the sick and get there and find a heart attack, so they can call for us. You get shot, it’s EMTs unless you get so shot up your unconscious or dead. That’s why sometimes we medics keep an ear to PD radio and take a quick ride over when there’s a shooting. If you “feel weird” you get EMTs unless you’re especially old or diabetic, then you get us. It’s all a little ridiculous but also there’sa weird logic to it. I’ll just say, when the man called the other night to tell 911 that he was unconscious, they made the job an “UNCONSCIOUS” and sent us. If you just had a seizure it’s EMTs but if you’re having one, even if you’re the one saying you’re having one, it’s a “STAT EP” (status epilepticus) and it’s medics. Even the guy that calls every other weekend because he feels like he’s about to have a seizure, but never actually does, even he gets medics, even though he’s actually an EDP and EDPs get EMTs.

Q: What’s an EDP?

A: Emotionally Disturbed Person. Aaah we could go on for hours about the many wondrous events that happen when folks don’t take their psych meds or lose their shit for one reason or another. Any of us could go EDP at any given moment, far as I can tell, cuz they range the range across all borders. Many jobs will start as DIFF BREATHER and end up as EDP when we get there and patient says something like “I haven’t been able to exhale for like three days,” or “I haven’t taken my psyche meds and I want to fucking kill somebody.” Sometimes EDPs hide behind locked doors, which makes them BARRICADED EDPs, or hide weapons places (“that’s just my rock…i keep him in a sock…” which makes them VIOLENT EDPs. They can also stand up on high places, when they become the JUMPERUP, and then fall, when they become JUMPERDOWN.

NYPD is always getting into a hot mess over EDPs and then having to get retrained on how to deal with them. Usually its cuz they get confrontational with em, and the last person you need to argue with is someone who’s completely disengaged from reality (“Sir, you need to go to the hospital.” “I am in the hospital…” “uh…”). It’s like arguing with the last drunk guy at the party. (most recently see: Iman Morales, who was screaming naked on a Bed Stuy fire escape before PD tasered him, causing him to fall to his death.)

Q: Do you really drive the ambulance?

A: We do and yes it’s really cool but blowing lights and parting traffic jams like the red sea is really not nearly as cool as some of the shit that happens in the back of the ambulance. But people are usually more excited about the woop-woop.

Q: What’s like the craziest shit you’ve ever seen?

A: Why do people always ask that like they’re the first person to think of asking it? I dunno, depends on when you ask I guess. I’ll probably blog about it sometime…

Q: Do people really call for stubbed toes?

A: Stubbed toes, runny noses, burning genitalia, crying babies. “I feel: tired, sick, lonely, strange, different, okay, weird…” “I have an appointment at the hospital.” “I just needed to get out of my house for a while.” “I was bored.” “I hate my husband.” “Can you look at this huge cyst I have on my nuts?” “My tooth hurts since like, three weeks ago.” “I don’t want to talk about it.” “I’m bleeding from vagina, same as i was about a month ago.” “i can’t get out of my chair but i don’t want to got to the hospital, just help me…get…unstuck…”

Those are really the vast majority of our calls. About 80% let’s say is freakish dumbshit and then 15% is like mildly important medical situations and the last 5 is really good urgent crazy shit. Depends on the week though.

Finally, I’ll end with this one:
We were called for the CARDIAC- 78 year old with chest pain. We arrive to find a dapper little elderly gentleman sitting calmly in his East New York apartment.
Whats the trouble today sir?
My heart is broken.
Excuse me?
It’s broken I say.
Does it…hurt?
It hurts a lot.
How…long has it been going on?
Oh quite a few years now.
You want to…go to the emergency room?
Yes please.

Well: I was really planning on the next piece i wrote being about all the mundane bullshit we do, which is like 90% of the job, especially cuz now i got fricken jud and saraivy telling me how i’m just trying to show off on facebook with all the gory shit we do…BUT, f them- cuz this week was Babalu’s day, and in his catholic form, Babalu was Lazarus, who Jesus famously raised from the dead, and in honor of this I somehow ended up with 2 Babalu-relevant jobs, and I’m sitting here bored out my skull so I will now share them with you.

1.
There’s this crackhead motel on 125 and Park. Everytime we go there it’s some scene out of The Wire or Pulp Fiction. Job comes in as first DIFFBREATHER, then UNCONCSCIOUS and then, inevitably, ARREST. Means the guy’s supposedly dead. We get there, walk up the rickety stairs and our dude is laid out doing a very loose impression of a dead person, surrounded by a swath of mortified and confused cops and fire fighters.

On a sidenote: this is a classic firefighter maneuver called The Circle Of Death: it’s when they get there first and form into a small circle of curious white faces looking down at the patient. It’s FDNY sign language for ‘what the fu-u-ck?’ Many a time we roll up on scene to find this peculiar huddle and it’s usually not a good sign.

Anyway, if you’re any kind of medical personnel you get good quick at knowing the difference between a true cardiac arrest and a guy that wants attention (the best are the fake seizures, when they go “I’m having a seizure!” and squirm awkwardly till they realize you’re not buying it). But firefighters and cops are not trained in this art, so they really were convinced. O and I took one look at the man and O set up the stair chair and i said “Get…up!”

First he squirmed and moaned and the firefighters all gasped. “Get up and get in my chair,” and reluctantly, he struggled to his feet and planted himself in our chair as the room fell completely silent.

We had ourselves a good chuckle driving back to our spot when it was all over. Not so much at the fireguys’ expense (a little though…) if not at the whole situation in general: here we are again in the midst of this whole huge bureaucratic clusterfuck, dozens of different agencies and crossed lines and legalities and so much work done covering ass and so little done treating patients, between dispatchers and insurance companies and godknows what kind of existential spiritual lifendeath tug-of-war, and right smack at the center of it all is five guys with helmets standing in a circle around one old bobo trying his best to look dead so he can get a night of sleep away from the other crackheads.

2.
That was Wednesday, December 17, sacred to San Lazaro, who shocked everyone by

emerging out of his grave on Jesus’ request and hobbles around town with his crutches and pack of dogs. On Saturday, the night of the annual Babalu cleaning ceremony, we had two back to back cardiac arrests.
The first was a 96 year old lady who was clearly well past gone, but when we walk in the fire guys go “oh! She was up and talking just before you walked in!” like it’s all our fault. This is pretty standard procedure especially when it comes to nursing homes- we get there, the patient’s rock solid with rigor mortis and the staff is talking bout how she was laughing and chatting not seconds before and how they can’t believe it, in fact she was walking around, walking I tell you! Playing freeze tag even! Lord- look how quick she went!
This lady was, as i said, gone but she didn’t fit the criteria for us to leave her in peace (rigor mortis, decomposition, dependent lividity-which is the pooling of fluids at the lowest point in your body, or a grim catch all called Obvious Death, which is for those guys that are just DEFINITELY not coming back, i.e. decapitated) . So we went ahead and started working her up. It ended up messy, firstly cuz she was old and must’ve had a terrible case of osteoporosis, because literally all of her ribs collapsed on my first round of cpr. Secondly, she had zero veins for iv access, (and we tried plenty) except as it turned out, a nice solid 1 going right down the center of her forehead, and that is exactly where the iv ended up. It seems crude, it is crude, i guess, but this is what it is: if you’re in or about to be in cardiac arrest, having a little saline-lock antenna popping out your head is not what matters, all that matters is that you have one. In that iv goes all the good medicine that we carry around that will bring you back, directly into your bloodstream and all across your body. So in retrospect, or from the comfort of all of our not-imminently-to-die selves it’s easy to squirm at the thought of all these gruesome details and invasions, but I’m telling you them precisely because that is the very heart and soul of emergency care. It’s by definition a sticky mess of bloodied gauze, discarded syringes and stained suction tubes matched only by the colliding and collapsing human disaster zones that it’s created to revive.

Which brings us to the second cardiac arrest of the night.
No wait, first, another sidenote:
Approximately 100% of the recently dead on tv and movies who are treated with a touch of poorly performed CPR come springing right back to life and go back to killing bad guys. Most notably, James Bond, who just one movie ago defibrillated himself back from the beyond and then went on playing poker straight away.
Yeah- that’s not how it works. First of all, it’s literally about 1-2% of people we get in arrest ever get a pulse back at all. In my five year career I’ve gotten 2 maybe 3 pulses back total. Second of all, and maybe most importantly, of those few the vast vast majority of them are total vegetable matter from then on out. You just can’t deprive a brain of oxygen for that long and pop back around like nothing happened, it doesn’t work that way. In NY the situation’s complicated even more by tall buildings, projects, traffic and numerous other obstacles delaying patient contact.

So, so so so, that means when it’s your time it’s your time, and most guys that’ve been working the field long enough know better than to walk into every arrest that comes over and raise the dead.

I was particularly feeling that way on Saturday, not just cuz of the first messy arrest, but because i was working with, oh let’s call him Gerk- a certain medic that I just wouldn’t trust giving treatment to anyone i knew or cared about or had ever met. At all. I mean- well his name says it all. And then I was even less thrilled, you can imagine (maybe…) when the second arrest of the night came over not long after we finished cleaning up the first one. Oh lord, i said to myself, this poor whomever, wrong night to flatline…

Whomever turns out to be a 72 year old Indian gentleman lying flat on his back in his underpants with a bright red flare of blood at his lips and nostrils and a burly EMT thumping up and down on his chest,. He has no signs of trauma and appears to be in good health except for a large unsightly triple bypass scar stretching across his chest (and the fact that he’s dead).

Our monitor says he’s flatline, so there’s no movement at all in the electricity of his heart, nothing to shock in other words, so I start looking for a place to put my iv while Gerk prepares his tube kit to get an airway. This guy has only slightly better veins than the last lady, and having no heartbeat doesn’t help, but i manage to sneak one in right along the top of his left hand. Gerk’s having trouble with the tube, to his credit the blood in the airway means he’s just staring into a dark tunnel of fluid, with surely no vocal chords in sight to pass the tube through. Eventually, we do get it though, and just when I’m thinking the EMT is gonna have his own cardiac incident from how hard he’s pumping and sweating, someone announces that they felt a pulse.

No shit, i think, but there it is- a vigorous thump-thumping along his carotid artery. There’s some excitement now as the crew shifts course, one EMT running off to get the stretcher, the other taking the blood pressure, Gerk on the phone with our on-line medical control to get more meds, me and the lieutenant prepping the patient for transport.
The family’s all there screaming and praying as we load up our post-arrest patient and stick him in the ambulance, and though I’m trying to be pessimistic I’m feeling good about this one right up until he arrests again as we’re flying along to the hospital. He’d come back strong with a solid blood pressure and the pulse way up in the high 140’s but halfway to Wyckoff his heart dropped back down to the 60’s, then 30’s, and while we’re frantically working on him he loses pulses again completely and we’re back to thumping his chest while trying to keep balance amidst the tossing and turning of Brooklyn streets.

As we pull up I check again and miracle of miracles, there it is, that rhythmic murmur of pressure against my finger… In the ER bay they do their usual half-joking complaining about how we have all the fun and get right to work on him, setting up a dopamine drip, getting a ventilator set up, etc. I can’t help but feel good, and I’m literally typing the first words of a jubilant text message to Gabi when I see all the nurses run over and a doctor start compressions again.
Crap! I shut the phone right quick and walk over cringing. For a third time though, our man decides to live that night, and this time he stays for good. When we leave the hospital he’s pumping away all by himself, but he's still, and maybe always will be, a vegetable.

Saturday Night. Gentrification has created these weird pockets of extreme wealth in that ambiguous part of town where Bed-Stuy and Prospect Heights overlap. Me and C wind our way through the corridors of some converted warehouse. It’s dim and dank and smells funny until we step suddenly into an ornately decorated apartment with frilly columns, oriental rugs and wall-to-wall theater memorabilia. A distraught, exhausted middle-aged woman ushers us into the bedroom where we find cops and volunteer EMTs swarming around a fat white male, obtunded like a goddamn beached whale and not breathing on the floor beside his king-sized bed.

My partner C was here last time this guy tried this, and he’s asking the wife what our patient took tonight but she won’t say. The EMTs get the bag-valve mask on to giving him respirations and I’m driving tonight, so i set up the IV while C gets down to where the patient is and starts looking for a vein. The guy’s teenage son is coming in and out, I’m trying to get a coherent story while squeezing saline into lines and ripping open plastic bags, but all we can get is that the guy was drinking all night, has been depressed, has tried this before, etc etc. There’s a not that says “Dear so-n-so i love you and i’m sorry’ and then it’s all garbly chicken scratch. PD was here a few months back cuz our man locked himself in a room with a gun (a BARRICADED EDP- more on that some other time…). He’s h e a v y like you wouldn’t believe and out like a pile a rocks. I pass C the tourniquet, then the catheter (a smallish one, cuz the fellow’s fat so he’s a tougher stick and there’s no reason for anything big), and when he reports that he’s in i hand over the iv lock and a flush of saline water along with the stickies to hold it on.

The pupils are pinpoint and his respirations are still almost none, so we have good reason to suspect a narcotics overdose. I pass C a needle with 2 mg of narcan- a medication so notorious in the heroin circles all you have to do is mention it and many addicts will come jumping out of their stupor just to beg you not to give it. Basically, it blocks all the opiate receptors in your body and completely and utterly deprives of you of any possible high you mighta had. Then, you go into instant withdrawal which can mean anything from extreme irritability to severe hibijibis to simultaneous shitting and vomiting to seizures. That’s why, to avoid prolonged cleanup/resuscitation sessions, narcan is best given a) in small polite doses and b) no more than two seconds before the patient gets moved out of the ambulance and into the er.

The Dreaded Narcan...

But a suicide is a horse of a slightly different color than a typical addict OD, especially when the guy is HUGE, has taken unknown mountains of unknown narcs and is already pretty far gone. So we drop in the two mgs, enough to make your average user do the shitnpuke right quick, and it doesn’t even touch him. Practically bounces off the guy. He’s still pinpoint, obtunded, not-breathing. A hot mess. And we’re all still wedged into this awkward space between the bed and the wall. I pass C an amp of dextrose, sugar water, in case on top of everything else he happens to be diabetic and hypoglycemic as well, and then another 2 mg of narcan. Then we start packaging to go, cuz he’s still not responding and we’re reaching our limit of options. It takes about five of us to get him, strap him to a board and get him moving. We’ve all carried some fatties, but this guy is solid, dead weight and managed to collapse into a particularly un-reachable corner of the master bedroom. So we heave and ho and finally begin carting him through the windy passage ways back towards the street.

Just before we make it back out I see his arm start to raise up, and slowly he blinks back into consciousness. He looks around groggily. His hands are taped together to keep them from flopping out of the stretcher. He has an iv in him. He’s surrounded by cops and medics. He looks each of us in the eye and says:
”Fuck you guys, why didn’t you leave me the fuck alone…” and then falls grumpily back into his stupor. Then he wakes up again as we loading him up. “Damn you. Damn you all. Motherfuckers…”

What do you say to a dude like this? I mean, none of us are really in it for the thank yous, but shiet- if yer gonna be hufuckingmongous and a big a-hole to boot, yer ass can walk to the ambulance or just keep it to yerself. But in the end, you say nothing. You chuckle. Brush it off and take homeboy to the hospital, where he proceeds to curse out each and every one of the nurses, security guards and techs and then falls back asleep.
And then you go get dinner.

Well- most of you know I spend my nights picking up busted up bronx and brooklynites and taking em to the hospital, but few of you really know what this job is like beyond the stupid stories i tell when drunk, so i thought i'd use this space to give you some idea of the day to day of the job.

Although, as i often say, this work is hardest cuz of just how much junk and non-emergency shit we deal with, really like %90 is total nonsense (from nosebleeds to stubbed toes- possibly the title of my memoir?...nope) but last night, amidst allllll that bullshit, my partner and i caught one of those few calls where we paramedics really get to actually do something that makes a damn difference to someone.

It was 530 am, a rainy dawn in Harlem. Call came in as a "diffbreather," i was sleeping in the stretcher (sooo comfortable...really, and not the bad dream factory you would imagine) and Ortiz was passed out in front, having exhausted all possibilities of online poker. Bleary eyed, we zipped over to an apartment complex on 130th by the FDR, lugged our 40 lbs of equip out the bus and headed up a few flights of stairs.

The dude was about 40, sweating profusely, clutching his chest and struggling to breath. He said this has happened before, his heart goes too fast, he can feel it pounding away in his chest. Far as calls go, this is fairly serious- meaning if left like this, yeah he'll drop in not too long, but probably won't go down in the next 10 seconds. Probably won't, but easily could.

Ortiz is the kinda partner that you can jump into action with and know he's taking care of his end of things without anyone having to speak. I'm taking the blood pressure, he's putting the guy on the monitor for an ekg. Sure enough, the dude's tachying away at 208 times a minute, whereas your heart really should be going between 60 and 100. Going this fast, his heart is not pumping effectively, the chambers aren't filling up fully, system's backing up, oxygen not being distributed well, etc etc until he's dead. And as his heart continues to become hypoxic (oxygen deprived) it can easily jump into any number of even more killuquick rhythms and make ass him out right quick.

But first a quick note about Adenosine: that's the drug we gotta use to bring this heart back into normal working order but it's a hardcore mess of a drug- the half life is about 10 seconds, meaning it needs to get where it's going, the heart, QUICK or it won't work at all. This means u gotta get a big needle into a big vein that's as close up the arm and towards the chest as possible and you gotta push the drug in fast and follow it with a big shot of saline to get it all the way thru.

This dude's veins are not big, in fact they're hiding. I finally find a juicy one, pop in the needle but there's no flash back, nothing to tell me i'm in, just empty catheter. And here's one of those cases where u really need that iv in there, not just some just-in-case c.y.a. nonsense. I dig a little, the guy doesn't mind cuz he's really more worried about his crashing heart, prod where the vein once was with my gloved finger, turn to the left a little then right and finally see a dot of dark blood in the chamber, followed by a small flood to confirm it's in. I advance the catheter, pop off the turniquet and connect up the line as Ortiz passes me a bag of saline to link it up with (see what I mean about him- the guy's on point!)

So now we're good, IV in, ready to go, but we still gotta push the shit, hope it works and it feels like everything's taking too long. All the while the guy's moaning in the background as his heart is racing along on the ekg.

I put the syringe of adenosine in the port, give Ortiz a flush of saline that he puts in beside mine. I count to 3, push the shit and he immediately pushes his. Then we step back and watch.

Now the crazy thing about Adenosine is that to work it actually stops your heart and restarts it again. I mean literally, you can watch it on the monitor, and the patient always goes "Oh...oh oh oh oh...ooooooo....uhhh" in some kind of painful/orgasmic dance with death and then let out a big sigh as their heart comes back at a reasonable rate. If it comes back at all... So when we give it we always step back and just kind of watch, ready to either jump into fevered action or grin and chuckle with the dude.

We watch. Still at 208, now 210, 206... he's still hurting. A minute passes with no change. We set up the next dose, 12 mg this time, grumbling slightly to ourselves and wondering if we're gonna end up tubing the dude.
When we're in position I count 3 again and we both push, flushing all that good stuff right down into his troubled heart. For about 30 seconds (seems like forever) he's the same and then:

Supraventricular Tachycardia, a pause, and back to normal...

A pause. He throws a couple ugly looking PVCs, which means the hearts irritable, then it stops dead for a second or two, (dude: "oh...oh oh oh ...uh...) and (sigh...) come back at a very reasonable 124 beats a minute. And he's smiling now. So am I. So is Ortiz, although there's certainly a little edge to both our grins as we pack up our stuff and plop the guy on our stairchair to bring him out.

Dawn's breaking over the east river outside. The morning commute is chugging along the FDR and two trains crisscross on the bridge above. A light rain is falling.

With the vague tingling thrill that comes from finally doing something tremendous and worthwhile after so much crap, we cart our now jovial patient off to our ambulance and away...

About Me

Daniel José Older's work has appeared in Strange Horizons, Crossed Genres, The Innsmouth Free Press, Flash Fiction Online, and the anthology Sunshine/Noir, and is featured in Sheree Renee Thomas' Black Pot Mojo Reading Series in New York City. When he's not writing, teaching or riding around in an ambulance, Daniel can be found performing with his Brooklyn-based soul quartet Ghost Star), with whom he recently completed a multimedia live music and dance documentary about the end of slavery in new york entitled City of Love and Disaster.
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